The treatment schedule below explains how the drugs for this treatment are given.

Capecitabine and lapatinib

This treatment cycle is repeated every 21 days. Your doctor will advise you of the number of treatments you will have.

Day

Treatment

How it is given

1 to 14

Capecitabine(KAP-e-SYE-ta-been)

Take orally TWICE a day on days 1 to 14 with a glass of water within 30 minutes of finishing a meal (just after breakfast and then again after evening meal).
Do not break, crush or chew tablets.
If you are unable to swallow the tablets whole they may be dissolved in water and the solution swallowed (see directions in Other information about your treatment).

1 to 21

Lapatinib(la-PA-ti-nib)

Take orally ONCE a day on an empty stomach, at least one hour before after eating food. Swallow whole with a glass of water, do not break, crush or chew.

If you are taking an antacid, do not take within two hours as this may interfere with its absorption

15 to 21

Do not take capecitabine tablets from day 15 to 21.

Missed doses:

Capecitabine or lapatinib: if you forget to take a tablet or vomit a tablet, take your normal dose the next time it is due. Do not take an extra dose.

Capecitabine tablets are available in two tablet strengths, 150 mg and 500 mg. It is important that you take the correct tablets and understand how to take them. Ask your doctor, nurse or pharmacist to complete the table below with the correct number of tablets for you.

Changes to your dose or treatment delays

Sometimes a treatment may be started at a lower dose or the dose needs to be changed during treatment. There may also be times when your treatment is delayed. This can happen if your doctor thinks you are likely to have severe side effects, if you get severe side effects, if your blood counts are affected and causing delays in treatment, or if you are finding it hard to cope with the treatment. This is called a dose reduction, dose change or treatment delay. Your doctor will explain if you need any changes or delays to your treatment and the reason why.

Blood tests and monitoring

Anticancer drugs can reduce the number of blood cells in your body. You will need to have regular blood tests to check that your blood cell count has returned to normal. If your blood count is low your treatment may be delayed until it has returned to normal. Your doctor or nurse will tell you when to have these blood tests. Tell your doctor if you are on an anticoagulant (medication used to treat or prevent blood clots) e.g. warfarin. You may need to have additional blood tests.

Other medications given during this treatment

Anti-sickness (anti-nausea) medication: you may be given some anti-sickness medication.Make sure you take this medication as your doctor or nurse tells you, even if you don’t feel sick. This can help to prevent the sickness starting.

Antidiarrhoeals: you may be given some medication to treat diarrhoea. Your doctor or nurse will tell you how and when to take your antidiarrhoeal medication.

Instructions for dissolving capecitabine tablets:

Capecitabine tablets should never be crushed, cut or broken.

You (or whoever is dissolving the tablets) should wear disposable gloves and try to minimise touching the tablets.

Put the tablet(s) needed for the dose into a disposable cup with a lid, if possible. If using a non-disposable cup, ensure the cup is kept only for this purpose.

Fill the cup with approximately 200 mL of water and cover with lid if available.

Leave the tablets in the water to dissolve, this may take up to 15 minutes. Gentle agitation of the solution may assist in the dissolving process, being careful not to spill the solution.

Once the tablets have fully dissolved, swallow the solution immediately.

In case of any spillages to skin, immediately wash the affected area thoroughly with warm soapy water. If spillage occurs to work surface or floor, wash area with warm soapy water and dry with absorbent paper towel or cloth. Dispose of cloth in a cytotoxic bag.

The tablets have a bitter taste. The solution may be made more palatable by dissolving the tablets in fruit juice (not citrus juice) or by adding cordial or flavouring.

To ensure that the whole dose is taken, swirl the cup with water and swallow. Repeat if necessary.

The disposable cup and gloves should be disposed of in a cytotoxic waste bag. Non-disposable cups should be washed thoroughly with warm soapy water.

Tell your doctor if you have a history of heart problems or high blood pressure.

Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get any of the symptoms listed above.

Early (onset days to weeks)

Infection risk (neutropenia)

This treatment lowers the amount of white blood cells in your body. The type of white blood cells that help to fight infection are called neutrophils. Having low level of neutrophils is called neutropenia. If you have neutropenia, you are at greater risk of getting an infection. It also means that your body can’t fight infections as well as usual. This is a serious side effect, and can be life threatening.

Wash your hands often.

Keep a thermometer at home and take your temperature regularly, and if you feel unwell.

Do your mouth care regularly.

Inspect your central line site (if you have one) daily for any redness, pus or swelling.

Tell your doctor or nurse immediately, or go to your nearest hospital Emergency Department if your diarrhoea is not controlled, you have 4 or more loose bowel motions per day, and if you feel dizzy or light-headed.

Mouth pain and soreness (mucositis)

You may have:

bleeding gums

mouth ulcers

a white coating on your tongue

pain in the mouth or throat

difficulty eating or swallowing.

Avoid spicy, acidic or crunchy foods and very hot or cold food and drinks.

Try bland and soft foods.

Brush your teeth gently with a soft toothbrush after each meal and at bedtime. If you normally floss continue to do so.

Chemotherapy safety

Blood clot risk

Cancer and anticancer drugs can increase the risk of a blood clot (thrombosis).

Tell your doctor if you have a family history of blood clots.

A blood clot can cause pain, redness, swelling in your arms or legs, shortness of breath or chest pain.

If you have any of these symptoms go to your nearest hospital Emergency Department.

Medications and vaccinations

Before you start treatment, tell your doctor about any medications you are taking, including vitamins or herbal supplements.

Don’t stop or start any medications during treatment without talking to your doctor and pharmacist first.

Paracetamol is safe to take if you have a headache or other mild aches and pains. It is recommended that you avoid taking aspirin, ibuprofen and other anti-inflammatory type medications for pain while you are having treatment. However, if these medications have been prescribed by your doctor, do not stop taking them without speaking with your doctor.

Vaccinations such as flu and tetanus vaccines are safe to receive while having treatment. Do not have any live vaccines during your treatment or for 6 months after it finishes. If you are unsure, check with your doctor before you have any vaccinations.

People you live with should be fully vaccinated, including having live vaccines according to the current vaccination schedule. Extra care needs to be taken with hand washing and careful disposal of soiled nappies for infants who have recently received the rotavirus vaccine.

Other medical and dental treatment

If you go to hospital or any other medical appointment (including dental appointments), always tell the person treating you that you are receiving anticancer drugs.

Before you have any dental treatment, talk to your doctor.

Diet

While you are receiving this treatment it is important that you try to maintain a healthy diet.

Grapefruit and grapefruit juice can interact with your medication and should be avoided while you are on this treatment.

Speak to your doctor or nurse about whether drinking alcohol is safe with your treatment.

If you have any concerns about recent weight loss or weight gain or questions about your diet, ask to speak to a dietitian.

Fertility

Some cancer treatments can reduce your fertility. This can make it difficult or impossible to get pregnant or father a child.

Talk to your doctor or nurse before you start any treatment. Depending on your situation there may be fertility sparing options available to you and/or your partner, discuss these with your doctor or nurse.

Pregnancy and breastfeeding

Some cancer treatments can be dangerous to unborn babies. Talk to your doctor or nurse if you think there is any chance that you could be pregnant.

Do not try to get pregnant or father a child during this treatment. Ask your doctor or nurse about what type of contraception you should use.

Do not breastfeed if you are on this treatment as anticancer drugs can also pass into breast milk.

Sex life and sexuality

The desire to have sex may decrease as a result of this treatment or its side effects.

Your emotions and the way you feel about yourself may also be affected by this treatment.

It may help to discuss your concerns with your partner and doctor or nurse.

For more information about cancer treatment, side effects and side effect management see our Patient and carers section.

Quit smoking information and support

Quitting smoking is helpful even after you have been diagnosed with cancer. The following resources provide useful information and support to help you quit smoking. Talk to your doctor, nurse or pharmacist about any other questions you may have.

This document is a guide only and cannot cover every possible situation. The health professionals caring for you should always consider your individual situation when making decisions about your care. Contact your cancer clinic staff or doctor if you have any questions or concerns about your treatment, or you are having problems coping with side effects. Use of this document is subject to eviQ’s disclaimer available at www.eviQ.org.au

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